Text-message surveys may help monitor flu outbreaksA text-message survey sent out May 12, 2009, to which more than 50,000 Mexican cell phone users responded, found that 17% of respondents reported influenza-like illness (ILI) symptoms, 49% of which were severe. Severe ILI was defined as inability to work, study, or maintain family care. Researchers compared these findings with a nationwide clinic-based surveillance system, which showed the percent of severe cases increasing from 36% on Apr 1 to a peak on Apr 26 of 58%. They said comparison of data from the text-message survey with clinic-based epidemic curves for pandemic H1N1 flu "showed less variability than expected; no geographic variation was detected." They conclude, "When carefully deployed, unstructured supplementary service data surveys may be a practical, low-cost, and timely complement to traditional surveillance." However, they caution that the low (5.8%) response rate hindered direct comparisons and recommend refinements to limit recall errors and increase the response rate.Aug 11 Emerg Infect Dis study

New Zealand emphasizes need to stay flu-alertNew Zealand's Ministry of Health (MOH) issued a reminder today that the country is still experiencing significant levels of pandemic H1N1 influenza, even though the World Health Organization declared the pandemic over yesterday. Deputy Director of Public Health Darren Hunt said in a press release, "The pandemic influenza strain is the predominant strain circulating this winter. . . .We are seeing higher levels of hospitalization in areas that weren't severely affected last year. To date, there had been over 300 people admitted to hospital this year with confirmed H1N1, which includes over 30 people admitted to intensive care." The MOH is encouraging vaccination and early medical attention.Aug 11 New Zealand MOH release

Serious H1N1 cases in China not tied to obesity, pregnancyChinese researchers dissecting data from the Notifiable Disease Surveillance System found about half of patients with serious, critical, or fatal pandemic H1N1 cases in China had no underlying disease, that obesity and pregnancy did not increase risk, and that heart disease and allergies did. They also found that those who did not receive prompt neuraminidase inhibitor therapy (flu antivirals) were at increased risk of death, and that those 6 to 17 years old were at lower risk. Writing in the Journal of Infection, they identified 475 severe, 73 critical, and 69 fatal H1N1 cases in 2009. Most deaths involved multiple-organ failure, with a median of 10 days from symptom onset to death.Aug 11 J Infect abstract

$100 million NIAID program will study human immune responsesUS officials today announced the launch of a 5-year, $100 million program to study the human immune system's responses to infection and vaccination, with the goal of providing better treatments and vaccines. The studies will be done at six "Human Immune Phenotyping Centers" around the country, with funds coming from the American Recovery and Reinvestment Act, according to the Department of Health and Human Services (HHS) in a release. The studies will focus on responses to viruses and bacteria such as influenza, West Nile, and pneumococcus. The investigators will analyze samples taken from groups such as children, the elderly, and those with autoimmune diseases before and after exposure to naturally acquired infections or vaccines, HHS said. Eventually the findings will be gathered into a Web-based database and made available to the scientific community. "This research effort represents a major expansion of efforts to define the principles of human immune regulation, instead of relying on findings from animal models that have limitations and cannot always be extrapolated to people," said Daniel Rotrosen, MD, director of the Division of Allergy, Immunology, and Transplantation at the National Institute of Allergy and Infectious Diseases (NIAID), which is administering the program. The institutions and principal investigators involved are Baylor Research Institute, Dallas, Jacques Banchereau, PhD; Dana-Farber Cancer Institute, Boston, Ellis Reinherz, MD; Emory University, Atlanta, Bali Pulendran, PhD; Mayo Clinic, Rochester, Minn., Gregory Poland, MD; Stanford University, Calif., Mark Davis, PhD; and Yale University, New Haven, Conn., David Hafler, MD, and Erol Fikrig, MD.Aug 11 HHS press release

Broadly resistant Gram-negative bacteria spreading, study saysEnterobacteriaceae that produce an enzyme that makes them resistant to carbapenem and many other classes of antibiotics are spreading in India and Pakistan and have been found in the United Kingdom as well, according to a study published by Lancet Infectious Diseases. The researchers looked for the enzyme, called New Delhi metallo-beta-lactamase 1 (NDM-1), in Enterobacteriaceae isolates from centers in India and Pakistan and from the UK's national reference laboratory. They found 37 NDM-1-positive isolates from the UK lab and a total of 136 from sites in India and Pakistan. The enzyme was found mostly in Escherichia coli (36 isolates) and Klebsiella pneumoniae (111), "which were highly resistant to all antibiotics except to tigecycline and colistin," the report says. It says Enterobacteriaceae with NDM-1 "potentially herald the end of treatment with beta-lactams, fluoroquinolones, and aminoglycosides—the main antibiotic classes for the treatment of Gram-negative antibiotics." The authors say these bacteria are potentially a major global public health problem, because there are few new antibiotics for Gram-negative bacteria in the pipeline and none that are active against NDM-1 producers. They also comment that several of the UK isolates came from Britons who had traveled to India or Pakistan for elective surgery. Since some other Europeans and Americans go to India for elective surgery, the resistant species are likely to spread worldwide, the authors predict.Aug 11 Lancet Infect Dis study